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The average licensed master’s level social worker, professional counselor, or master’s level psychologist has been in school for at least six to seven years and possesses at least a bachelor’s and master’s degree, and completed supervised work experience. Not to mention they have prepared for, taken, and successfully passed the licensure exams in the state in which they reside. The average doctoral level licensed psychologist has gone to school for at least nine to eleven years, completed several unpaid and paid internship experiences and supervised clinical practice after graduation to become licensed, and passed the licensure exams. Professionals are trained to read, understand, and correctly interpret clinical scientifically valid research for the purpose of supporting interventions to effectively help clients and pass on knowledge.

Nearly four in ten adults in the population report symptoms of persistent anxiety and depression regularly and the number of children, teens, and adults who experience lasting stress, loneliness, and mental health symptoms is on the rise. Over twenty percent of the population takes some sort of prescription medication for a mental health treatment and only ten percent have sought or received counseling. This is compounded by economic hardships, financial instability, discrimination, inequality, and lack of access to clinical care. Exacerbated by the pandemic and political unrest, over ninety percent of the population feels that the United States and the world as a whole is in the midst of a mental health and overall identity crisis. Additionally, the mental health and related medical fields face tremendous rates of compassion fatigue, burnout, high turnover, and vicarious trauma that impact providers and lead to a high demand for care and a large clinician shortage.

As a result, people often turn to self-help books or gurus, social media professionals, and pop psychology that has permeated the zeitgeist and added therapeutic terms to the social lexicon. This creates both a dark storm cloud and a silver lining in the psychological field for professionals to reconcile within ourselves. The silver lining is we are destigmatizing mental health and openly talking about how it is okay not to be okay. People are asking for help and attempting vulnerability, and this promotes connection and reduces loneliness. However, the downside of this is that people are misusing research, therapeutic terms, or lack the understanding of complex psychological diagnoses. Professionals study for years to just begin to understand the complex human experience. Psychology diagnoses are complicated and nuanced and cannot be learned in one person’s lived experiences, self-help books, or social media TikTok posts. Terms like gaslighting, narcissistic, bipolar, and boundaries are commonly used to describe past relationships that ended. If this is in an attempt to understand, that can be great, but it is commonly used to justify or excuse your one’s choices while blaming another person.
Throwing around nuanced terms without accountability and self-reflection trivializes the genuine experiences of those people who have suffered from a mental health diagnosis. This has been a reoccurring problem since people began to use terms like OCD, ADHD, “crazy or schizo” to describe the quirky habits of themselves or another individual. Ask anyone who can assess for, diagnosis, treat, or has these conditions, and they will explain it can feel demeaning or disrespectful to throw around terms with very little understanding for people who genuinely see these disorders daily in their therapy room or real life. Most people are not OCD, ADHD, autistic, or narcissists, and using these words casually in a social context as if you know that is an accurate diagnosis can be problematic. Blog posts with the title like ‘ten traits of all people with ADHD’ have been found to rarely be scientifically supported and not every person can fit into a neat little box, not to mention these are not peer reviewed scientific studies. Even experienced clinicians will consult with colleagues and other professionals about diagnoses, assessments, and interventions to ensure we are diagnosing clients correctly, because of the associations with these labels.

And even if referring to yourself and not to others, consider not using words like “narcissistic,” or telling people you “disassociate” or are “OCD” or “so ADHD” – realize having heard these terms on social media or read about them, and even if you may see some similarities in your life, that is not the same as having a professional diagnosis. These are real symptoms and diagnoses, and the people that have honestly experienced this firsthand may feel more and more isolated and misunderstood when the public uses words like this casually.

Despite some of the professionals on social media or television being actual professionals or published authors with licensure, recognize not everyone is a licensed professional or actually working in the field they are proselytizing about to the masses. Always fact check things you hear and engage in critical thinking, and if you have to process complex personality nuances or past relationship baggage then work with a professional who can help you reconcile your perspective and self-reflect to prevent unhealthy patterns from continuing. This year, set an intention to choose your words carefully and instead of labeling or ‘armchair diagnosing’ a person or a problem or yourself, choose instead to recognize that doing that can ostracize and demean not only the mental health field, but the people that genuinely struggle with these real occurrences, and can limit the meaning of these psychological terms, minimizing the legitimate impact. Remember words are powerful, and it is important to use psychological words correctly and carefully, to support all who live with mental health diagnoses.

Hopefully, reunification therapy (RT) is successful, and then it is obviously done. But for families who feel stuck in RT and like they are not making progress, the lament often becomes, “Are we done yet?!” Which is a fair question. Attorneys and judges also struggle with this question in cases where one or more family members are asking to stop RT.

At Lepage Associates, where we have been doing RT for over 20 years, we have found getting clients to understand up front the breadth of what entering into RT really means – what it will take from all family members, the commitment, and why do it at all – results in more success, thus now we provide clients and attorneys with written information before we even take the case, to help set the stage for success. (For a copy of our Understandings & Agreements Form and our RT Handouts, email: tlepage@lepageassociates.com.  We welcome the Handouts to be shared and used with any family, even if they do not come to us for services, because we believe the information benefits children and families). Attorneys and judges also need to realize that most RT cases take several months (a year is not uncommon), as people start very entrenched in their positions, and therapy must begin with the RT therapist having several 1-1 sessions with each parent and child before starting joint sessions, to help ensure benefit is gained from joint sessions.

So, when is reunification therapy done? Let’s look at some of the nuances and complexities that can arise. The goal of reunification therapy is, as the name implies, to repair the relationship of a parent and child who have become disconnected in some way. So, in very simple terms, RT is finished when the relationship is repaired.

1. Ideal/Success: RT is DONE when the rift is healed, and the parent and child have a healthy relationship. (Note: healthy relationships are not perfect.) Indicators of success would be the parents and child talking mostly positively about the family relationships, forgiveness of past wrongs paired with current healthy behaviors, and the child being willing and even happy to spend time with the parent they previously had the rift with. This is an ideal and is the healthiest outcome in terms of present and future mental health for the child and for the parents.

Does this above sound quick? Often it is not quick! In fact, to the opposite, it can take significant time and continued effort. This means if the family members (most notably the parents) do not have the inclination to stick with RT over many, many months, then this level of success will not be achieved in the current RT. Still, there is another form of success…

2. Solidly Better/Good Enough Success: RT CAN ALSO BE DONE when the relationship is improved enough such that it is no longer a major source of emotional pain and/or anger for the family members, and there is some connection between parent and child where previously there was little or none. Indicators of this would be the negative rhetoric between family members is tamped down quite a bit, they can see some positives in one another, and the child is willing to spend time with the parent they previously had the rift with (and sometimes enjoys that time even if also feeling neutral about that time together often).

Is this ideal? No, but lots of families exist in this space of some connection, without being truly close. Children do not have to have the same level or type of connection in their relationship with each both parents to have positive relationships with both. If the relationship where there was a negative rift now lives in the land of neutral to positive, that’s a win. And it creates a foundation for possible future growth. Clearly, Option #1 is better for long term mental health, but this option is perfectly reasonable, normal, and healthy.

If clients have the inclination to stick with RT and strive for Option #1 above, that’s great, but professionals must also recognize that many families, who have never even had a divorce or any rift, live their whole lives in this zone, making it normal. It is normal and natural for a child to be closer to one parent versus another, often a result of more similar personalities, perspectives, values, and/or shared interests. It is also normal to enjoy time with some family members more than others. It is important all family members realize this is normal and does not mean anything negative about either parent or the child. (Having said that, I can recognize the two sides of this coin: the deep love for a child and drive to get to Option #1 and the reality that this two Option #2 is a totally normal occurrence in families.)

3. A Little Better/But Probably Not Good Enough Success: RT is PROBABLY NOT DONE YET when things are a little better, but not by much. Indicators of this would be slightly less negativity between family members, and a begrudging willingness (resignation to) on the child’s part to spend time with the other parent. On one hand, if RT ends here, this little shuffle forward is still a win, because any improvement in the disenfranchised parent-child relationship is positive. But there is more likelihood for regression, and on the upside, there is evidence this family can make shifts forward. Some sustained time and effort in this realm might get move the family into the ‘Solidly Better/Good Enough Success’ realm. However, that is the perspective of a therapist. Some judges might move the family into the ‘Solidly Better/Good Enough Success’ realm. However, that is the perspective of a therapist. Some judges might decide if the child is now willing to spend time with the parent, that the family should not be ordered to spend time and money on more therapy, and these practical realities need to be considered on a case-by-case basis.

4. No Improvement! /So Do We Stop?!: The two ends of this success-failure continuum are where one most clearly sees a hard stop. In above, RT ends because the relationship is truly repaired. But here in the land of no movement and seeming failure, one wonders how long family members should engage in therapy.

5. Give me a quantitative answer in time/months/sessions, not the qualitative descriptions above! As a practical matter, attorneys and judges often want to know how much time one should linger in the realm of ‘A Little Better/But Probably Not Good Enough Success’ or ‘No Improvement’ before ending the RT effort all together. This topic is emotional because the complex and seemingly heart wrenching question is not really about when RT ends, but is – “When do we give up on this parent-child relationship? At least for now?”

Therapists are remiss to provide a timeline because research shows children do best when they have a relationship with both parents, even if the parents are separated, and even if the relationships are imperfect. In contrast, no relationship or a highly poor one affects social-emotional development and can have an adverse impact through adolescence and into adulthood, negatively impacting education outcomes, childhood social-emotional adjustment, and mental health in adulthood. RT can help prevent these outcomes by restoring relationships and helping children (and their parents) learn lifetime skills about conflict resolution, forgiveness, and boundary setting. Therapists are also remiss to place a timeline on RT because people, and families, all progress at different paces in therapy. If you had 10 people with anxiety or depression (or trauma or relationship issues, etc.) who all entered therapy at the same time, their symptoms would abate at differing rates; there would not be one timeframe that ‘worked’ for all. Thus, we hope these qualitative descriptions above help provide some useful framework for instances where you are trying to decide if RT is ‘done’ or should continue.

“So…what exactly is a forensic psychologist?” 

This is one of the most common questions we receive at Lepage Associates when clients or attorneys are looking for the best kind of support for their legal cases. Though the title “forensic psychologist” often conjures up misleading images from crime shows, psychologists can genuinely play a pivotal role in multiple parts of the legal process.  

As expert witnesses, psychologists can provide both factual testimony and clinical opinions in family, civil, and criminal courts. Psychologists typically provide their educational background, curriculum vitae (CV), and other relevant information about their clinical and forensic experience. If asked to testify, a psychologist must be qualified as an expert in court with the judge’s approval. The psychologist may testify as a general expert on a topic, as an expert specific to the parties and case if he or she has treated or evaluated a party. Therapists also sometimes testify as a fact witness versus an expert witness.

An attorney can retain a psychologist to speak about their research – or the general state of the science – on a particular topic. In these instances the psychologist is acting as a general expert (on the topic), versus an expert who has meet with any of the parties and evaluated them specifically. For example, an expert on childhood trauma could provide information on trauma symptoms to a judge or jury. A psychologist can also speak on a topic of concern (e.g., parental alienation) by defining it, describing it for the court, and describing how it manifests or is relevant to the legal case. 

As an expert witness and evaluator, a forensic psychologist can be retained for specific legal matters and fairly and objectively answer such questions. Psychologists can provide both written evaluations and oral expert testimony. Many forensic evaluations include common elements – clinical interviews, collateral interviews (e.g., treatment providers, family, friends), psychological testing, a review of records, and conclusions. Records can be wide in scope and include legal documents, mental health records, depositions, emails/texts between parties, and copies of social media posts. The content and test selection, however, differ significantly based on the court and referral question. Evaluators testify as expert witnesses since they form a clinical opinion on the case.

Another avenue where psychologists can give helpful information is as a treating psychologist, i.e., therapist. If a plaintiff, defendant, or other court-involved party has a psychologist as an individual therapist, that therapist can comment on the course of treatment with their client as a fact witness. As a fact witness, however, a treating psychologist could not answer questions such as, “Do you believe he or she was insane at the time of the offense?” For a therapist to be asked about their clinical opinion, they should be sworn in as an expert.

Family Court 

Psychologists can assist attorneys and judges in divorce, custody, and guardianship or legal capacity cases. Psychologists can conduct full scale custody evaluations to help determine the ideal custody arrangement for parents and children, parental capacity evaluations that assess an adult’s ability to safely parent their children, or general psychological evaluations for children and adults to provide clinical information and treatment recommendations to the court. Testing can include but is not limited to personality tests and assessments of parental stress, substance use, or anger. By conducting thorough evaluations, forensic psychologists can weigh in with their clinical opinions and diagnostic impressions. Family courts can also determine a person’s competency to make medical, financial, or legal decisions, and intelligence, memory, and cognitive testing can give insight into specific capacities for certain types of decision-making. 

Civil Court

Civil court sees a wide breadth of cases. One common area for psychologists to give expert opinions is regarding emotional distress and mental health problems incurred by a plaintiff. Personality tests and trauma inventories can help elucidate the extent of such distress. Immigration evaluations by psychologists are also commonly requested in civil court. 

Criminal Court

In criminal court, psychologists are often court-appointed to conduct competency evaluations to help determine if a defendant can “understand and assist” in the trial process. Tests of personality and psychological functioning, specific competency assessments, and tests of malingering with validity scales are common for competency evaluations. Psychologists can also perform general psychological evaluations and risk assessments to gauge an individual’s risk of future violence or sexual offense. The results of these evaluations allow psychologists to give specific recommendations for treatment and risk reduction to benefit both community safety and the defendant. Contrary to media portrayals, the “insanity defense” is only raised in one percent of cases. However, forensic psychologists are qualified to evaluate someone’s mental state at the time of the offense.

In Summary…

This article explained a few of the ways psychologists can be integral participants in legal cases, and how they can. Testify, which is most often as an expert witness versus as a fact witness. The examples included are not exhaustive. The scope of psychologists’ involvement in the legal system continues to grow. Legal professionals have increasingly turned to psychologists to give insight into important and sometimes ambiguous questions about individuals, families, and capacity for change. Forensic psychologists possess the training and expertise to help courts make informed decisions that affect millions of people. If you are a legal professional or a client who is court-involved, consider consulting with a forensic psychologist to assist in objective and fair representation.

The stress, fear and uncertainty created by the COVID-19 pandemic can wear anyone down, but children and teens may have an especially tough time coping emotionally. Children and adolescents that were coping with mental health issues prior to COVID-19 are likely to have increased symptomatology.

Home confinement has restricted children from their normal lifestyles, and this influences their mental and physical health. Children rely on their peers to converse, be entertained, play sports, socialize, distract, grow, and learn and to be included. COVID-19 took this away without warning. What once were their coping skills and outlets are now gone.

Children and teens are not used to being with their nuclear family 24/7. Parents went to work, children went to school, followed by after school programs or sports, and at dinner time either the family gathered at the table or went out to eat and spent time together. This routine provided for change in environment, structure, socializing, and family time in increments that were counted on for balance and outlets of emotion and energy. 

Children and teens cannot grasp the concept of the pandemic like adults do and to lose life as they know it is hard to make sense of. Isolation and social distancing have eliminated the things we had taken for granted. “You don’t know what you have until it’s gone” explains so much. Children and teens did not realize how the normal day to day activities and interactions played a role in how they feel. But now, with no outlets, the feelings of loneliness, depression, anxiety, anger, and fear can be even more overwhelming. The first and most important step is to talk to and observe your child for changes in their day to day functioning.

You may not hear these feelings directly from your children, so it is important to take note of the following symptoms:

• Isolating more than normal 
• Heightened irritability
• Sleeping and eating pattern changes
• Loss of interest in what was interesting before
• Increased emotional dysregulation or moodiness
• Lethargy 

These are only a few signs that may indicate your child may benefit from mental health support.  With the pandemic, you may not realize that help is still available. The option of teletherapy, as well as in the office sessions, can help children get the therapy they need.